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BackgroundAcute coronary syndrome (ACS) remains a leading cause of mortality globally. Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI). While ticagrelor has demonstrated favorable myocardial effects in preclinical studies, limited clinical data compared its impact on left ventricular (LV) remodeling versus clopidogrel.ObjectiveTo evaluate and compare the effect of ticagrelor and clopidogrel on LV remodeling among ACS patients post-PCI.MethodsEligible participants were adults (≥18 years) with confirmed ACS who were prescribed ticagrelor or clopidogrel for at least 3 months after PCI and had complete echocardiographic data at baseline and within one-year follow-up. Patients with missing follow-up imaging, switching between antiplatelets, contraindications to DAPT, or noncompliance were excluded. Echocardiographic parameters-LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF)-and B-type natriuretic peptide (BNP) were assessed, and multivariable regression models adjusted for confounders.ResultsA total of 137 patients met criteria (87 on ticagrelor, 50 on clopidogrel). Ticagrelor was associated with an adjusted LVEDV reduction of 8.17 mL compared with clopidogrel (95% CI -15.84 to -0.50; P = .039), an LVESV reduction of 8.09 mL (95% CI -13.88 to -2.29; P = .007), and a greater LVEF improvement of 4.05% (95% CI 2.41-5.70; P < .001). The reduction in BNP was also greater with ticagrelor by 73.56 pg/mL (95% CI -144.08 to -3.05; P = .043).ConclusionTicagrelor was associated with more favorable LV remodeling parameters compared with clopidogrel in this cohort. These findings warrant confirmation in randomized trials.